Individual
MARY C KOOGLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP ONC
Contact information
Practice address
100 7TH STREET, GROTTOES, VA 24441-0489
(540) 249-5901
(540) 249-5902
Mailing address
100 SEVENTH ST, GROTTOES, VA 24441
(540) 249-5901
(540) 249-5902
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024-120331
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007795050
—
VA
01
—
270565
ANTHEM
—
Enumeration date
08/09/2005
Last updated
08/14/2012
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